右美托咪定鼻腔内给药在近期上呼吸道感染的儿童心导管置入术中的应用：随机对照试验
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Intranasal dexmedetomidine premedication in children with recent upper respiratory tract infection undergoing interventional cardiac catheterisation：A randomised controlled trial
背景与目的
近期上呼吸道感染(URI)是围手术期呼吸道并发症(PRAE)发生的危险因素。这种风险在患有先天性心脏病(CHD)的儿童中可能更高，特别是接受介入性心脏置管手术的儿童。因此，在这些儿童中调整麻醉方案是必要的，以防止PRAE的发生。本研究探讨鼻内滴注右美托咪啶(DEX)是否能降低近期上呼吸道感染患儿介入性心导管置入术术后PRAE的发生率。
方 法
共有134名近期上呼吸道感染并接受介入性心导管置入术的冠心病儿童纳入研究，年龄范围在0-16岁之间。麻醉诱导前30-45分钟随机接受右美托咪定1.5ug.kg-1(右美托咪定组)或生理盐水(安慰剂组)鼻腔内给药。
结 果
鼻内滴注右美托咪定显著降低了PRAE的发生率(P=0.001)，尤其是在氧饱和度降低的情况下(P=0.012)。PRAE多发生在初期。三种类型的左向右分流型冠心病患儿的PRAE发生率在右美托咪定组和生理盐水组均具有可比性。在小于3岁的儿童中，右美托咪定组的PRAE发生率显著低于对照组(P=0.003)。相反，在3岁以上的儿童中，PRAE的发病率在两组之间无显著差异。两组苏醒期烦躁、发热、呕吐的发生率差异无统计学意义(P>0.05)。
结 论
麻醉诱导前30-45min鼻腔内持续滴注右美托咪定1.5ug.kg-1可降低3岁以下、近期有上呼吸道感染并接受介入心导管置入术的儿童PRAE的发生率。
原始文献摘要
Zhang S, Zhang R, Cai M,et,al.Intranasal dexmedetomidine premedication in children with recent upper respiratory tract infection undergoing interventional cardiac catheterisation：A randomised controlled trial[J].Eur J Anaesthesiol 2020 Feb;37(2) DOI：10.1097/EJA.0000000000001097
BACKGROUND Recent upper respiratory tract infection(URI) is a risk factor for the occurrence of peri-operative respiratory adverse events (PRAE). This risk may be higher in children with congenital heart disease (CHD), particularly in those undergoing interventional cardiac catheterisation. It is therefore essential to adapt the anaesthetic strategy in these children to prevent from the occurrence of PRAE.
OBJECTIVE To determine whether intranasal dexmedetomi-dine (DEX) premedication can reduce the incidence of PRAE in children with recent URI undergoing interventional cardiac catheterisation.
DESIGN Randomised controlled trial.
SETTING Single-centre study based at a tertiary care centre in Shanghai, China.
PATIENTS A total of 134 children with CHD aged 0 to 16 years with recent URI undergoing interventional cardiac catheterisation.
INTERVENTIONS Children were randomised to receive either intranasal DEX 1.5ug/kg(DEX group) or intranasal saline (Placebo group) 30 to 45 min before anaesthesia
induction.
MAIN OUTCOME MEASURES The incidence of PRAE.
RESULTS Intranasal DEX significantly reduced the incidence of PRAE (P¼0.001), particularly oxygen desaturation (P¼0.012). Most PRAE were observed during the emergence phase. The incidence of PRAE was comparable among the three types of left–right shunt CHD children in both groups. In children aged less than 3 years, the incidence of PRAE was significantly lower in the DEX group (P¼0.003). In contrast, the incidence of PRAE was comparable between the two groups in children aged at least 3 years. No differences in the incidence of emergence agitation, fever and vomiting between the two groups were noted.
CONCLUSION Administration of intranasal DEX 1.5ug/ kg 30 to 45 min before induction led to a reduction in the incidence of PRAE in children aged less than 3 years with recent URI undergoing interventional cardiac catheterisation.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：牛振瑛 编辑：冯玉蓉 审校：王贵龙